Comment / Balancing act

The election is over. I don’t know about you, but it felt like a long build-up to it this time. And the pollsters proved it is not just the NHS that has a bit of trouble with its forecasting.

Whatever your political shade and whether you feel pleased or disappointed by the result, we now at least have some certainty as to the way forward. The message is one of continued austerity. I don’t think we really expected anything else.

The post-election NHS now has to provide some momentum in delivering more integrated services, improve performance, meet increasing expectations on quality and make inroads into the financial deficits that have emerged right across the country.

This is a time for finance staff to be on the front foot as the financial position becomes increasingly the focus of attention. It’s a great time to be involved in the development of new service models and payment methods. There’s a real feeling of excitement in Manchester as the devolution agenda gathers pace and Greater Manchester develops its strategic plan for services.

The Five-year forward view vanguard pilots are forging ahead and finance staff will be involved in the governance and financial arrangements for the models. And new ‘vanguards’ are being encouraged, building on the proposals set out in the Dalton report.

Tariff and payment methods will also be up for review. A new approach to the tariff for urgent and emergency care is already well under consideration and there will be more changes as Monitor explores capitated budgets and uses more detailed patient-level costs to inform tariffs.

The government has promised £8bn to the NHS over the next five years. But we have to remember that is on the back of finding efficiency savings of £22bn. That is likely to mean less tolerance of local idiosyncrasies. Organisations will be asked increasingly to demonstrate that good practice is in place in terms of the basics.

There will be no defence for the absence of a good procurement strategy and a rigorous approach to product standardisation, supported by clinical colleagues. Similarly the drive for safe staffing levels will not excuse the absence of robust controls on agency spend. Back-office functions will have to demonstrate value for money, whether they be outsourced or provided in house.

Nobody in NHS finance would argue with the need for efficiency. But we need to be given a fighting chance of success. We need targets that are stretching, but achievable and tariffs that support system transformation rather than trying to drive it.

And any more changes to national policy, such as the roll-out of seven-day services, must be targeted to local need and supported by appropriate funding.

The agenda for the next five years will need new skills to be developed. Finance departments will have to demonstrate a technology-driven, efficient approach to transactional services, switching the emphasis to being true business partners. My feeling is that NHS finance staff will embrace all of that.

The call for submissions for the HFMA Awards has just gone out and I know that we will see some great examples of good practice, innovation and strong leadership within the entries.

The will to improve and transform is there, but there needs to be some hope of success if we want to improve morale and keep staff with us.

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